Part of the book: Diabetes Mellitus
Acute kidney injury is a very relevant feature in the liver cirrhosis. Acute renal failure is due to prerenal factors, intrinsic factors of the kidney, or postrenal. Prerenal damage is the result of renal hypoperfusion without damage to the glomeruli or renal tubules. Without treatment, prerenal acute renal failure can progress to acute tubular necrosis, a type of intrinsic renal damage. Patients with cirrhosis are prone to developing acute kidney injury. The acute decrease of the kidney function contributes to the mortality of patients with cirrhosis. The potential triggers of acute kidney injury should be recognized and removed; this includes the discontinuation of diuretics and nephrotoxic drugs, the treatment of infections and gastrointestinal bleeding, and plasma expansion in case of hypovolemia. The new International Club of Ascites-Acute Kidney Injury in cirrhosis criteria provide a simple and relevant staging system for acute kidney injury in patients with liver cirrhosis based on relative increases in serum creatinine. Vasopressors such as terlipressin and norepinephrine in combination with intravenous albumin represent the first-line therapy for hepatorenal syndrome.
Part of the book: Management of Chronic Liver Diseases
The nonalcoholic fatty liver disease (NAFLD) is the liver disorder that is most common in Western countries; has a global prevalence of approximately 25%; and is strongly associated to obesity and metabolic syndrome. According to the Third National Health and Nutrition Examination Survey (NHANES III), the prevalence of NAFLD is more common in obese individuals with a prevalence of 39.4% than in lean individuals with a prevalence of 7.7%. Nonalcoholic fatty liver disease is the hepatic manifestation of the metabolic syndrome and is defined as the accumulation of fat in the liver. The NAFLD is defined by an accumulation of fat in liver with >5% of steatosis by histologic examination or by proton density fat fraction >5.6%. The diagnosis of NAFLD implies the exclusion of secondary causes like alcohol consumption. The NAFLD includes two different pathological conditions with different prognosis: the nonalcoholic fatty liver (NAFL) and the nonalcoholic steatohepatitis (NASH), the last one has a wide spectrum of severity.
Part of the book: Liver Cirrhosis
Cardiovascular disease in populations with obesity is a major concern because of it is epidemic proportion. Obesity leads to the development of cardiomyopathy directly via inflammatory mediators and indirectly by obesity-induced hypertension, diabetes, and coronary artery diseases. Metabolic disturbances such as increased free fatty acid levels, insulin resistance, elevated levels of adipokines, myocardial remodeling, activation of the sympathetic nervous and renin-angiotensin-aldosterone systems, and small-vessel disease are the most important mechanisms in the development of obesity cardiomyopathy. The myocardial changes related with obesity are increasingly recognized, and they are independent of classic risk factors as hypertension, coronary artery disease, and obstructive sleep apnea. There is a wide range of evidence: the association between heart failure and obesity shown in epidemiologic studies; the confirmation of the association of adiposity with left ventricular dysfunction, independent of hypertension, coronary artery disease, and other heart diseases; and experimental evidence of functional and structural changes in the myocardium in response to increased adiposity support the existence of a cardiomyopathy related to obesity.
Part of the book: Visions of Cardiomyocyte